Delivering Bad News Tom Poulton MD

What exactly is “Bad News”

What we’re gonna do here Why is this so hard? Can we make this fun? Can we make this doable? OMG. Will I survive this?

“Never break bad news---it will only get you in trouble.” Bonus Points: What famous personality made this statement?

Just how is this going to go? For me? For the family?

The difficulty We want to ease suffering, not trigger it Little or no training Facing our own mortality Facing our children’s vulnerability Violates “the natural order” of things Universal fear of failing

What else? Fear of lawsuits Fear of someone shooting the messenger Fear of misdirected anger Fear of properly directed anger Fear of failing my duties

Who should do this job?

Who should do this job? The Doctor Why??

How about delegating this one? Who should not do this job? Everyone else.

What’s the research on this? Not born knowing how to do it. It’s a learned behavior Certain things are considered forbidden Families value certain things The impact lasts a long time

What do families value? Apparent Medical Competence Honesty Taking time Crystal clear language Effective communication Good listening No jargon

Preparing Read Think Roll play Team planning and feedback

The best prep? Happened before today Role playing? Honesty --Self --Others Being at peace with the big picture

Immediate Preparation “This is a part of my job” “I am calm” “I can do this” “Doesn’t have to be world class” Shift gears Know pt’s name and DOB Know events Accept your limitations

Immediate Preparation If you are lucky enough, you can build a relationship with the family right now.

The setting Location, location, location! Seats for all Private Telephone if no cell service Amenities

Who will be there? Your team? Family “team”?

Details, details Make sure all team members on same page Clean clothes---check each other Sit down Focus on parents---not the pushiest person “Warning shot”---use surrogates

An “Approach” A Plan: setting, people, do it. Get it done Family Info---what do they know? Explain clearly what they do not know Then say it. “I am terribly sorry to have to tell you that Heather just died.” Pause. Pause some more. Make certain they got it. Let them express whatever they must Answer questions honestly, simply, completely Be willing to sit in that moment. Accept, validate. Reassure---explain the death was painless if you can honestly do so Develop plan for next ten minutes How to reach me

Then shut up Do not say stupid stuff Monitor what you say

What constitutes “stupid stuff”? He’s gone to a better place. God needed another little angel. At least you still have two healthy kids. Your other kids need you to be strong for them You’re young. You can have another child. He’s with God It will get better I feel your pain God doesn’t give us more than we can handle Pray more and you will be at peace I know exactly how you feel I understand completely; when my ______ fell off the ____ and broke her ____, I nearly ______!

I dunno---what if I cry?!

What can I say? We are all very sorry that you are having to experience this terrible loss. Then be quiet. For a very long time.

Coping and moving on My, that sucked. I still feel sad later I am having anxiety attacks We are all grouchy and irritable